This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.11.054v1 47/7/1433    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (49) Citing Articles via Google Scholar Google Scholar Articles by Shivalkar, B. Articles by Vrints, C. Search for Related Content PubMed PubMed Citation Articles by Shivalkar, B. Articles by Vrints, C.

CLINICAL RESEARCH: CARDIOVASCULAR EFFECT OF SLEEP APNEA

Obstructive Sleep Apnea Syndrome

More Insights on Structural and Functional Cardiac Alterations, and the Effects of Treatment With Continuous Positive Airway Pressure

Department of Cardiology and Pulmonary Medicine, University Hospital Antwerp, Antwerp, Belgium.

Manuscript received July 14, 2005; revised manuscript received October 10, 2005, accepted November 8, 2005.

^_* Reprint requests and correspondence: Dr. Bharati Shivalkar, Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. (Email: bharati.shivalkar{at}skynet.be).

Presented in part at the European Society of Cardiology, Vienna, August 2003, and the Euroecho Scientific Sessions, Athens, Greece, December 2004.

OBJECTIVES: We studied structural and functional cardiac alterations in obstructive sleep apnea (OSA), their relationship to the severity of OSA, and the effects of treatment with continuous positive airway pressure (CPAP).

BACKGROUND: Obstructive sleep apnea may influence the cardiac function by several mechanisms in the awake patient.

METHODS: Left and right ventricular morphology and function were studied using echocardiography before and after treatment with CPAP in symptomatic patients (Epworth sleepiness score, 10 ± 4.8) with severe OSA (apnea-hypopnea index [AHI], 42 ± 24). The patients (n = 43, 32 men) had no known cardiac disease and were obese (body mass index, 31.6 ± 5.4 kg/m²). The same echocardiographic parameters were studied in age-matched overweight patients (n = 40; body mass index, 26.4 ± 2.3 kg/m²).

RESULTS: The patients were hypertensive (systolic blood pressure, 153 ± 25 mm Hg), with a higher resting heart rate (77 ± 10 beats/min, p = 0.008) compared with age-matched control patients (n = 40). There was right ventricular dilatation, hypertrophic interventricular septum, reduced left ventricular stroke volume, tissue Doppler-determined systolic and diastolic velocities of the left and right ventricle, and normal pulmonary artery pressure. The structural and functional parameters were significantly associated with AHI (p < 0.004). Multiple stepwise regression showed the interventricular septum thickness, right ventricular free wall, and mitral annulus tissue Doppler systolic velocities to be predictive of a higher AHI (p < 0.001). Six months after treatment with CPAP, significant improvements were observed in the symptoms and hemodynamics, as well as left and right ventricular morphology and function.

CONCLUSIONS: The structural and functional consequences of OSA on the heart are influenced by the severity of AHI. These effects are reversible if the apneic episodes are abolished.

Abbreviations and Acronyms   AHI = apnea-hypopnea index   BMI = body mass index   CPAP = continuous positive airway pressure   EEG = electroencephalogram   ESS = Epworth sleepiness scale   OSA = obstructive sleep apnea

This article has been cited by other articles:

				J.-P. Baguet, G. Barone-Rochette, P. Levy, E. Vautrin, H. Pierre, O. Ormezzano, and J.-L. Pepin Left ventricular diastolic dysfunction is linked to severity of obstructive sleep apnoea Eur. Respir. J., December 1, 2010; 36(6): 1323 - 1329. [Abstract] [Full Text] [PDF]

				M. R. Bonsignore, S. Battaglia, A. Zito, C. Lombardi, and G. Parati Sleep apnoea and systemic hypertension Sleep Apnoea, December 1, 2010; 150 - 173. [Abstract] [Fulltext] [PDF]

				T. Bitter, N. Westerheide, L. Faber, D. Hering, C. Prinz, C. Langer, D. Horstkotte, and O. Oldenburg Adaptive servoventilation in diastolic heart failure and Cheyne-Stokes respiration Eur. Respir. J., August 1, 2010; 36(2): 385 - 392. [Abstract] [Full Text] [PDF]

				Y. Koshino, H. R. Villarraga, M. Orban, C. J. Bruce, G. S. Pressman, P. Leinveber, H. K. Saleh, T. Konecny, T. Kara, V. K. Somers, et al. Changes in Left and Right Ventricular Mechanics During the Mueller Maneuver in Healthy Adults: A Possible Mechanism for Abnormal Cardiac Function in Patients With Obstructive Sleep Apnea Circ Cardiovasc Imaging, May 1, 2010; 3(3): 282 - 289. [Abstract] [Full Text] [PDF]

				N. Haruki, M. Takeuchi, Y. Kanazawa, N. Tsubota, R. Shintome, H. Nakai, R. M. Lang, and Y. Otsuji Continuous positive airway pressure ameliorates sleep-induced subclinical left ventricular systolic dysfunction: demonstration by two-dimensional speckle-tracking echocardiography Eur Heart J Cardiovasc Imaging, May 1, 2010; 11(4): 352 - 358. [Abstract] [Full Text] [PDF]

				S. Bailes, M. Baltzan, D. Rizzo, C. S Fichten, R. Grad, N. Wolkove, L. Creti, R. Amsel, and E. Libman Sleep disorder symptoms are common and unspoken in Canadian general practice Fam. Pract., August 1, 2009; 26(4): 294 - 300. [Abstract] [Full Text] [PDF]

				N. Haruki, M. Takeuchi, H. Nakai, Y. Kanazawa, N. Tsubota, R. Shintome, R. M. Lang, and Y. Otsuji Overnight sleeping induced daily repetitive left ventricular systolic and diastolic dysfunction in obstructive sleep apnoea: quantitative assessment using tissue Doppler imaging Eur Heart J Cardiovasc Imaging, August 1, 2009; 10(6): 769 - 775. [Abstract] [Full Text] [PDF]

				N. Akar Bayram, B. Ciftci, T. Durmaz, T. Keles, E. Yeter, M. Akcay, and E. Bozkurt Effects of continuous positive airway pressure therapy on left ventricular function assessed by tissue Doppler imaging in patients with obstructive sleep apnoea syndrome Eur Heart J Cardiovasc Imaging, May 1, 2009; 10(3): 376 - 382. [Abstract] [Full Text] [PDF]

				Y. Hayashi, G. J Barron, and A. A Almeida Operative Timing for Absent Pulmonary Valve with Obstructive Sleep Apnea Asian Cardiovasc Thorac Ann, December 1, 2008; 16(6): e52 - e54. [Abstract] [Full Text] [PDF]

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717. [Full Text] [PDF]

				H. A. Chami, R. B. Devereux, J. S. Gottdiener, R. Mehra, M. J. Roman, E. J. Benjamin, and D. J. Gottlieb Left Ventricular Morphology and Systolic Function in Sleep-Disordered Breathing: The Sleep Heart Health Study Circulation, May 20, 2008; 117(20): 2599 - 2607. [Abstract] [Full Text] [PDF]

				S. Kiekens, Veva De Groot, T. Coeckelbergh, M.-J. Tassignon, P. van de Heyning, Wilfried De Backer, and J. Verbraecken Continuous Positive Airway Pressure Therapy Is Associated with an Increase in Intraocular Pressure in Obstructive Sleep Apnea Invest. Ophthalmol. Vis. Sci., March 1, 2008; 49(3): 934 - 940. [Abstract] [Full Text] [PDF]

				S. Javaheri Treatment of obstructive and central sleep apnoea in heart failure: practical options Eur. Respir. Rev., December 1, 2007; 16(106): 183 - 188. [Abstract] [Full Text] [PDF]

				L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, B. C. Silva, E. M. Krieger, and G. Lorenzi-Filho Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling Chest, May 1, 2007; 131(5): 1379 - 1386. [Abstract] [Full Text] [PDF]

				V. Patruno, S. Aiolfi, G. Costantino, R. Murgia, C. Selmi, A. Malliani, and N. Montano Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea Chest, May 1, 2007; 131(5): 1393 - 1399. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al. Highlights of the Year in JACC 2006 J. Am. Coll. Cardiol., January 30, 2007; 49(4): 509 - 527. [Full Text] [PDF]

				W. T. McNicholas, M. R. Bonsignore, and the Management Committee of EU COST ACTION B26 Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities Eur. Respir. J., January 1, 2007; 29(1): 156 - 178. [Abstract] [Full Text] [PDF]

				H. Nakashima, T. Katayama, C. Takagi, K. Amenomori, M. Ishizaki, Y. Honda, and S. Suzuki Obstructive sleep apnoea inhibits the recovery of left ventricular function in patients with acute myocardial infarction Eur. Heart J., October 1, 2006; 27(19): 2317 - 2322. [Abstract] [Full Text] [PDF]